Provider Demographics
NPI:1245757152
Name:WEBBER, JENNIFER CHRISTINA (APRN)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:CHRISTINA
Last Name:WEBBER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3046
Mailing Address - Street 2:
Mailing Address - City:MALVERN
Mailing Address - State:PA
Mailing Address - Zip Code:19355-0746
Mailing Address - Country:US
Mailing Address - Phone:580-249-3027
Mailing Address - Fax:
Practice Address - Street 1:330 S 5TH ST STE 103
Practice Address - Street 2:
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73701-5860
Practice Address - Country:US
Practice Address - Phone:580-249-3027
Practice Address - Fax:580-234-5970
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-23
Last Update Date:2019-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK91272363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health